Portable camera aided simulator (PortCAS) for minimally invasive surgical training

ABSTRACT

The present disclosure is directed to a system and method for surgical training with low cost, reusable materials and a highly customizable virtual environment for skill-building. According to various embodiments, a surgical training tool is usable in conjunction with a support structure configured to at least partially constrain the tool movement. Meanwhile, the tool is tracked in real-time with off-tool detectors to generate a tool path driving a virtual rendering of the surgical training tool in an operative environment. The virtual rendering may be visually observable via a display device and may include a customizable and/or selectable operative environment with one or more structures that can be operated on by the virtual surgical training tool. By tracking the virtual tool interaction with the virtual structures, a task path may be established for documenting and/or objectively assessing the performance of one or more operative tasks.

PRIORITY

The present application claims priority under 35 U.S.C. § 119(e) to U.S.Provisional Patent Application Ser. No. 61/831,884, titled PORTABLECAMERA AIDED SIMULATOR (PortCAS) FOR MINIMALLY INVASIVE SURGICALTRAINING, By Ka-Chun Siu et al., filed Jun. 6, 2013, or is anapplication of which currently co-pending application(s) are entitled tothe benefit of the filing date. The above-referenced provisional patentapplication is hereby incorporated by reference in its entirety.

TECHNICAL FIELD

The present disclosure generally relates to the field of surgicaltraining systems and, more particularly, to a simulation system forminimally invasive surgical training.

BACKGROUND

Minimally invasive surgeries are highly favored in modern medicine dueto the reduced trauma and rapid recovery rates. However, work hourrestrictions have set a cap on the time that surgeons can train, andlaparoscopic training is especially difficult when trainees can onlyspend a limited amount of time in the operating room. To make up for thereduced training time, trainees are urged to spend non-working timemastering the fundamental skills of laparoscopic surgery.

Trainee evaluation is now standardized via the Fundamentals ofLaparoscopic Surgery (FLS) offered by the Society of AmericanGastrointestinal and Endoscopic Surgeons (SAGES). The FLS programrequires all trainees to acquire a special trainer box and testingmaterials to practice five simple tasks: peg transfer, precisioncutting, ligating loop, and suturing with extracorporeal knot andintracorporeal knot. The trainer box and consumable materials increasethe financial burden on trainees. Unfortunately, trainees also need toidentify and travel to certain FLS testing centers with a trained FLSproctor to take the FLS test.

Simulation is one solution to increase the time that surgeons can trainfor laparoscopy. Availability of simulators in surgical residenceprograms is often limited, which hampers the ability of simulators tomake additional training available for surgeons. Current simulators arecostly and fail to provide trainees with the requisite training andassessment opportunities of the FLS program. There is a need in the artfor low cost trainers that can adequately replace the consumable FLSmaterials while continuing to offer trainees the requisiteskill-building exercises and an objective assessment of their mastery ofthe fundamental skills over time.

SUMMARY

In one aspect, this disclosure is directed to system for surgicaltraining. In an embodiment, the system includes a surgical training toolincluding one or more fiducials and a support structure configured toreceive the surgical training tool and constrain the tool movementwithin a volume. To some degree, the support structure may mimic thelimited movement that would be encountered in a minimally invasivesurgical environment. Additionally, the system includes at least twooff-tool detectors configured to detect the position of the one or morefiducials. For example, a laparoscopic instrument, such as a grasper ora cutter, may be tracked by detecting the position of one or morefiducials associated with the positioning and orientation of the toolbody and movement of the operative tool head (e.g., claw, prongs,scissor, needle, or razor blade).

The system may further include at least one processor in communicationwith the off-tool detectors. A tool path may be generated by theprocessor based on the detected position (e.g., three-dimensionalcoordinates) of the one or more fiducials. The tool path may by mappedby the processor to a virtual rendering of the surgical training tool inan operative environment. The virtual rendering may be visuallyobservable via a display device, thereby enabling performance of anoperative task within the virtual operative environment utilizing thevirtual surgical training tool which is manipulated based on the toolpath (e.g., the mapped position coordinates of the fiducials detected byreal-time tracking of the surgical training tool). In furtherembodiments, the interaction between the virtual surgical training tooland one or more structures in the virtual operative environment may betranslated into a task path by the processor. As discussed in furtherdetail below, the task path can be analyzed in real-time, periodically,at specified triggering events, or post-performance of an operative taskto establish an objective assessment of the task performance.

In another aspect, the disclosure is directed to a method of surgicaltraining. In an embodiment, the method includes the steps of: detectingthe position of one or more fiducials of a surgical training tool withat least two off-tool detectors; generating a tool path based on thedetected position of the one or more fiducials; displaying a virtualrendering of the surgical training tool in a virtual operativeenvironment, the virtual surgical training tool being manipulated in thevirtual operative environment based on the tool path, thereby enablingperformance of an operative task within the virtual operativeenvironment utilizing the virtual surgical training tool; and generatinga task path based on the tool path, the task path describing a path ofthe virtual surgical training tool in the virtual operative environment,the task path including position coordinates of the virtual surgicaltraining tool relative to position coordinates of one or more structuresbeing operated on by the virtual surgical training tool in the virtualoperative environment.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not necessarily restrictive of the present disclosure. Theaccompanying drawings, which are incorporated in and constitute a partof the specification, illustrate subject matter of the disclosure.Together, the descriptions and the drawings serve to explain theprinciples of the disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The numerous advantages of the disclosure may be better understood bythose skilled in the art by reference to the accompanying figures inwhich:

FIG. 1 is an isometric view of a system for surgical training, inaccordance with an embodiment of this disclosure;

FIG. 2A is an isometric view of a surgical training system, where aportable support structure functions as a portable container for variousstorable components of the system, in accordance with an embodiment ofthis disclosure;

FIG. 2B is a side view of a surgical training system, where a portablesupport structure functions as a portable container for various storablecomponents of the system, in accordance with an embodiment of thisdisclosure;

FIG. 3 is a block diagram illustrating a detection and simulation pathof the surgical training system, in accordance with an embodiment ofthis disclosure;

FIG. 4A is a conceptual illustration of a visually observable virtualrendering of a surgical training tool in a virtual operativeenvironment, in accordance with an embodiment of this disclosure;

FIG. 4B is a conceptual illustration of a visually observable virtualrendering of a surgical training tool in a virtual operativeenvironment, in accordance with an embodiment of this disclosure;

FIG. 5 is a flow diagram illustrating a method of tracking a tool pathof a surgical training tool and translating the tool path into a virtualrendering of a surgical training tool in a virtual operativeenvironment, in accordance with an embodiment of this disclosure;

FIG. 6A graphically represents a tool path, in accordance with anembodiment of this disclosure;

FIG. 6B graphically represents a task path based on the tool path, inaccordance with an embodiment of this disclosure;

FIG. 6C graphically represents a task path relative to one or moreassessment variables, in accordance with an embodiment of thisdisclosure; and

FIG. 7 is a flow diagram illustrating a method of surgical training, inaccordance with an embodiment of this disclosure.

DETAILED DESCRIPTION

Reference will now be made in detail to the subject matter disclosed,which is illustrated in the accompanying drawings.

FIGS. 1 through 7 generally illustrate embodiments of a system andmethod for surgical training. To alleviate the burdens of limitedtraining time and the expenses associated with high-end simulators, thesystem described herein may include low cost, reusable materials and ahighly customizable virtual environment for skill-building. As detailedbelow, the system may enable objective assessment of a trainee'sperformance of operative (skill-building) tasks by tracking a tool pathof a surgical tool and translating the real-world tool operation (i.e.,the tool path) into a simulated setting where operative tasks can beperformed on virtual structures.

In FIG. 1, a system 100 for surgical training is illustrated accordingto an embodiment of this disclosure. The system 100 may include at leastone surgical training tool 102, such as a laparoscopic instrument, amodel of a laparoscopic instrument, or any other surgical instrument ormodel thereof. The surgical training tool 102 may include one or morefiducials coupled to the tool 102 or forming a portion of the tool 102.The fiducials may include, but are not limited to, active markers (e.g.,LEDs), passive markers (e.g., reflectors), and/or recognizable features(e.g., tool structures or patterned surfaces).

In some embodiments, the surgical training tool 102 includes one or morefiducials at the tool tip 104 to enable tracking of the tip status. Forexample, the position of the one or more fiducials may indicate anopen/close or active/inactive operating state of the tool tip, which mayinclude a claw, prongs, a scissor, a needle, a razor blade, or the like.Alternatively, the tip status may be tracked by detecting the positionof one or more fiducials located at a driving mechanism 103 of the tooltip 104. The driving mechanism 103 may include a handle, lever, button,knob, dial, or any other interface structure configured to actuate oraffect the operating state of the tool tip 104.

The surgical training tool 102 may further include one or more fiducialslocated along a shaft leading to the tool tip 104, thereby facilitatingdetection of the orientation of the tool tip 104. Those skilled in theart will appreciate that the surgical training tool 102 may include anynumber of fiducials located at the tool tip 104 and/or other portions ofthe tool 102. Through the use of active/passive detection, imagerecognition, and/or pattern recognition, the fiducials are detectable toidentify a position and orientation of the tool within a volume.

The system 100 may further include a support structure 108 configured toreceive the surgical training tool 102, via an opening, joint, notch, orthe like. In some embodiments, for example, the support structure 108includes a pivotable receiving structure 110, such as a gimbal joint.The support structure 108 may constrain the tool movement within thevolume, thus mimicking the limited movement that would be encountered ina minimally invasive surgical environment (e.g., tool manipulationthrough an incision).

In some embodiments, the system 100 further includes a platform 106 thatdefines the tool space. For example, the platform 106 may includeindications for proper placement of the support structure 108 and atleast two off-tool detectors 112. The support structure 108 may includea base 107 configured to removably attach to the platform 106, andsimilarly the off-tool detectors may include fasteners for coupling withthe platform 106. It is noted, however, that the support structure 108and/or the detectors 112 are not necessarily coupled with a platform orrestricted to a fixed arrangement. Rather, the support structure 108 andthe detectors 112 may be arranged with respect to the platform 106 orindependent of a platform 106. In some embodiments, where the system 100lacks or is independent of a platform, the support structure 108 and thedetectors 112 may be arbitrarily positionable with respect to oneanother. As discussed in further detail below, a registration sequencebetween the surgical training tool 102 and the detectors 112 may beperformed upon initiation to calibrate the detectors 112 and determineany needed repositioning.

The system 100 may further include at least a second surgical trainingtool 114 with one or more fiducials coupled thereto or forming a portionof the second tool 114. The one or more fiducials may be arranged toenable tracking of a position, orientation, and/or operating state of atool tip 116 of the second surgical training tool 114, where the tooltip 116 may be actuated, opened/closed, or activated/deactivated by adriving mechanism 115 of the second tool 114. The second surgicaltraining tool 114 may be positioned within a second support structure118 (e.g., within a pivotable receiving structure 120 of the secondsupport structure 118), where the second support structure may include abase 117 for attaching to a platform 106 or freely standing independentof a platform 106. In some embodiments, the first surgical training tool102 and the second surgical training tool 114 may be at least partiallysupported and constrained by a single support structure (not shown). Forexample, a shared support structure may include two receivingstructures, such as gimbal joints, each configured to receive arespective one of the first and second surgical training tools 102 and114.

In some embodiments, the system 100 further includes a portablecontainer configured to hold some or all of the foregoing components ofsystem 100. The one or more support structures may be disassembledand/or collapsed to facilitate storage within the portable container.Further, the portable container may include designated compartments orsupports that correspond to particular ones of the storable componentsof system 100. Accordingly, the surgical training tool 102 (and/or tool114) and detectors 112 may be conveniently carried from one place toanother, for example, from an instructional facility to home. In someembodiments, the detectors 112 may be connected or connectable to aprocessor, for example, linked via a wired or wireless connection to apersonal computer or any other computing system. As such, the system 100may be established at any site by connecting the detectors 112 to acomputing system including a display device. Alternatively, the system100 may include a portable display device coupled to a processor. Thoseskilled in the art will appreciate that the various components of system100 that are described herein may be configured for use at a single siteor for portability to multiple sites (e.g., a self-contained portablesystem or usable with any computing system).

An embodiment of system 100 is illustrated in FIGS. 2A and 2B, where thesystem 100 includes a collapsible structure 146 configured to supportthe first surgical training tool 102 and/or the second surgical trainingtool 114. The collapsible structure 146 may further constrain themovement of the surgical training tools 102 and 114 within the volume.For example, the collapsible structure 146 may include a first receivingstructure 154 configured to receive the first surgical training tool 102and/or a second receiving structure 156 configured to receive the secondsurgical training tool 114. In some embodiments, the collapsiblestructure 146 is defined by a top surface 148 and a bottom surface 150connected via a cross bars 152 in a scissor-like arrangement. As shownin FIG. 2B, the top surface 148 and the bottom surface 150 may beactuated towards one another in a closed position, where the cross bars152 are moved from a first end (open position) to a second end (closedposition) of one or more substantially linear openings 153 coupled withthe top surface 148 and/or the bottom surface 150. In the closedposition, the collapsible structure 146 may contain storable componentsof the system 100, as discussed above with regard to the portablecontainer. In some embodiments, the off-tool detectors 112 coupled to orsupported by the top surface 148 and/or the bottom surface 150. The topsurface 148 and/or the bottom surface may further include one or moreillumination sources (e.g., LEDs) configured to illuminate the volumewithin which the surgical training tool 102 is manipulated. In someembodiments, the illumination sources are configured to providesubstantially uniform illumination within the volume to maintain a clearfield of view for the detectors 112.

FIG. 3 is a block diagram illustrating a detection and simulation pathof the system 100. The system 100 may include at least one processor 124in communication with the off-tool detectors 112. The detectors 112 maybe configured to detect the position of the one or more fiducials of thefirst surgical training tool 102 and/or the second surgical trainingtool 114. Thereafter, a tool path may be generated by the processor 124based on the detected position (e.g., three-dimensional coordinates) ofthe one or more fiducials relative to a reference point, such as adesignated origin within the volume, a point between a first detector112 and a second detector 112, or a point on or near one of thedetectors 112.

In some embodiments, the detectors include cameras configured tostereoscopically image the volume within which the surgical trainingtool 102 is operating. By extracting the position coordinates of the oneor more fiducials from a series of stereoscopic images, the tool pathmay be constructed by the processor. For example, the processor mayrecord a path of tool coordinates over time. The tool path may furtherinclude tool orientation and/or information regarding the operatingstate of the tool tip 104. In this regard, the tool path may include adata construct formed from several attributes (e.g., position,orientation, tool tip operating state) that are tracked by detectingfiducial positions over time.

The system 100 may further include a display device 126, such as an LCD,LED, CRT, or plasma display, virtual reality (VR) goggles, a holographicdisplay, a projector, or any other 2D or 3D graphical display. The toolpath may by mapped by the processor 124 to a virtual rendering 130 ofthe surgical training tool 102 in a virtual operative environment 128that is visually observable via the display device 126. Accordingly,performance of an operative task within the virtual operativeenvironment 128 is possible utilizing the virtual surgical training tool130, where the virtual tool 130 is manipulated based on the tool path(e.g., the mapped position coordinates of the fiducials detected in realtime). In some embodiments, where a second surgical training tool 114 isalso tracked, the processor 124 may be further configured to generate asecond tool path based on the detected position of one or more fiducialsof the second surgical training tool 114. The processor may be furtherconfigured to map the second tool path to a virtual rendering 132 of thesecond surgical training tool 114.

The virtual operative environment 128 observable via the display device126 may facilitate single or multiple tool training with operative taskstargeting certain skills. FIG. 4A illustrates an embodiment where thevirtual operative environment 128 includes a task training environment.For example, the virtual operative environment 128 may include one ormore moveable structures 140 (e.g., rings) and one or more stationarystructures 142 (e.g., pegs). In the peg transfer exercise, the operativetask is to transfer a ring from one peg to another peg. Other possibleexercises include, but are not limited to, precision cutting along aspecified path, rope running, needle passing, intracorporeal knot tying,extracorporeal knot tying, mesh alignment, and/or suturing. FIG. 4Billustrates an embodiment where the virtual operative environment 128includes a more advanced surgical training environment. For example,surgical training simulations may include a virtual operativeenvironment 128 akin to actual operating conditions. In this regard, thesurgical training environment may include a virtual rendering of atleast one anatomical structure 144. The operative task may include theperformance of an operation (e.g., cutting or suturing) upon theanatomical structure 144. To facilitate progressive skill training,fundamental skill building simulations (e.g., simulations within a tasktraining environment) may be completed, and afterwards, the virtualoperative environment 128 may transition into more realistic surgicalsimulations (e.g., simulations within a surgical training environment).

The system 100 may further include one or more visual indicators 131and/or 133 conveying simulation data such as, but not limited to, toolmetrics (e.g., speed, positioning, direction, orientation, and/oracceleration), simulation time, current performance, averagedperformance, task completion rate, an amount or number of tasksperformed, percentage completed, number of errors, error rate, and/oraccuracy. As shown in FIG. 4B, the one or more indicators 131 and/or 133may be observable via the display device 126. In some embodiments, afirst indicator 131 may convey simulation data pertaining to the firstvirtual surgical tool 130, and a second indicator 133 may conveysimulation data pertaining to the second surgical tool 132. Further, asdiscussed above, the system 100 may include one or more indicatorsconveying information pertaining to both tools or to the overallsimulation. In some embodiments, the system 100 may further includehaptic feedback devices (e.g., resistance servos and/or vibrators)coupled to the surgical training tool 102 to simulate forces encounteredin the virtual operative environment 128.

A flow diagram in FIG. 5 illustrates an embodiment of a method 200 fortool tracking and simulation. The processor 124 may be configured toexecute one or more software modules or instruction sets to perform thesteps of method 200. At step 202, image frames or spectral data may becollected with the off-tool detectors 112. At step 204, the detectedframes or spectral data are processed to locate the one or morefiducials. At step 206, the fiducials coordinates are translated into aposition of the surgical training tool 102 or, more particularly, theposition coordinates of the tool tip 104. In some embodiments, themethod 200 further includes a motion analysis step 208, where changes infiducial positioning between frames can be used to determine changes inorientation, trajectory, and/or operating state of the tool tip 104. Atstep 210, a tool path is generated with the position determination overa series of image frames and, in some embodiments, the motion analysisdata. At step 212, the tool path is fed (in real time) to a simulationmodule. At step 214, the simulation module, running on the processor124, converts the tool path into motions of the virtual surgicaltraining tool 130 within the virtual operative environment 128.

The processor 124 may generate a task path describing a path of thevirtual surgical training tool 130 relative to the virtual operativeenvironment 128. The task path or a set of task paths may includeposition coordinates of the virtual surgical training tool 130 relativeto the position coordinates of one or more virtual structures (e.g.,structure 140, 142, or 144) being operated upon within the virtualenvironment 128. Further, the task path or paths may includetime-indexed events, such as performed operative tasks, errors (e.g.,dropped objects, misaligned cuts, and/or deviations beyond spatialthresholds), and other performance related attributes (e.g., toolsteadiness, speed, accuracy, and/or precision).

FIGS. 6A through 6C illustrate the tool path and the relationshipbetween the tool path and the task path according to various embodimentsof this disclosure. Looking to FIG. 6A, a three-dimensional plot 300 isillustrative of the tool path relative to an origin established betweenthe detectors 112 and the surgical training tool 102. In someembodiments, the origin may be established prior to initiating a tooltracking sequence by performing a calibration exercise with the surgicaltraining tool 102. FIG. 6A further illustrates a first two-dimensionalplot 302 of the tool path in the X-Y plane, a second two-dimensionalplot 304 of the tool path in the X-Z plane, and a third two-dimensionalplot 306 of the tool path in the Y-Z plane. Further, a time-indexed plot400 of the tool path is shown including individual traces 402, 404, and406 for the detected X, Y, and Z coordinates, respectively, over time.

As shown in FIG. 6B, the tool path can be referenced to coordinates 308of one or more virtual structures (e.g., structure 140, 142, or 144) togenerate a task path. In some embodiments, the task path includes ashifted version of the tool path about an origin defined by thecoordinates 308 of a virtual structure. In FIG. 6B, the virtualstructure coordinates happen to be at the same origin; however, thoseskilled in the art will appreciate that the virtual structurecoordinates 308 may shift the tool path about a different origin. Insome embodiments, the task path may simply include the coordinates ofone or more virtual structures in addition to the tool path, therebydocumenting deltas between the tool path and the coordinates of one ormore virtual structures. In FIG. 6C, spatial boundaries are illustrated.For example, boundary lines 310 and 312 illustrate movement tolerancesalong the X-axis, and boundary lines 314 and 316 illustrate movementtolerances along the Z-axis. In some embodiments, the task path may beassessed based on the time or extent of the tool path that is in/out ofthe spatial boundaries. Further, as discussed above, the smoothness orsteadiness of the tool path may be objectively assessed.

As further shown in FIG. 6C, one or more timing events (e.g., events 408and 410) or intervals (e.g., time between events 408 and 410) may existin the time domain. In some embodiments, an event 408 may include abenchmark, such as performance of a certain operative task or a portionthereof, where the task path may be assessed by comparing theperformance of an operative task to a benchmark for performing theoperative task. In some embodiments, two events 408 and 410 may definean interval wherein spatial boundaries are changed. For example, thespatial boundaries may become tighter or looser with respect one or moreof the axes as the task path progresses beyond a first operative task toa second operative task. Further, as discussed above, the task path mayinclude certain time-indexed events. In some embodiments, an objectiveassessment may be based upon the performance or non-performance ofcertain events within a time interval, and/or the task path may beassessed based on an error threshold established for a time intervalbetween two events (e.g., events 408 and 410).

The task path can be analyzed in real-time, periodically, at specifiedtriggering events (e.g., events 408 and 410), or post-performance of anoperative task to establish an objective assessment of the taskperformance. Looking again to FIG. 3, the processor 124 may beconfigured to provide a continuous, periodic, event-triggered, orpost-performance assessment of the operative task. Alternatively or inaddition to providing a performance assessment, the processor 124 may beconfigured to store the task path and/or a recording of the virtualsurgical tool 102 being manipulated within the virtual operativeenvironment 128 to a storage medium such as, but not limited to, a flashdrive, a hard-disk drive, a solid-state disk drive, or an optical disk.The stored task path or the recording may be retrieved and assessed at alater time by the processor 124 or at another site, such as aninstructional facility.

In some embodiments, the system 100 further includes a communicationlink, such as wired or wireless transmitter, configured to send the taskpath and/or a recording of the virtual surgical tool 130 beingmanipulated within the virtual operative environment 132 to a remoteserver 136 for assessment. Further, the displayed rendering of thevirtual surgical tool 130 and the virtual operative environment 128,and/or any other software modules may be accessible from the remoteserver 136 via the communication link 134. In some embodiments, one ormore access links to one or more simulations are provided through a webportal observable via the display device 126 or another user interface.The web portal may provide access to a selectable set of virtualoperative environments supporting one or more virtual surgical toolsand/or a customizable environment. Alternatively, the simulations may bestored on a non-transitory carrier medium, such as the storage medium138, that is communicatively coupled to the processor 124.

FIG. 7 is a flow diagram illustrating an embodiment of a method 500 ofsurgical training. In some embodiments, method 500 is manifested by anembodiment of system 100; however, those skilled in the art willappreciate that the method 500 may be carried out by any systemconfigured to perform the following steps. At step 502, at least twooff-tool detectors 112 may detect the position of one or more fiducialsof a surgical training tool 102. At step 504, a tool path is generatedbased on the detected position of the one or more fiducials. At step506, a virtual rendering of the surgical training tool 130 in a virtualoperative environment 128 is presented via a display device 126, wherethe virtual surgical training tool 130 is manipulated in the virtualoperative environment 128 based on the tool path. Accordingly, a traineeis enabled to perform an operative task within the virtual operativeenvironment 128 utilizing the virtual surgical training tool 130. Atstep 508, a task path is generated based on the tool path, where thetask path describes a path of the virtual surgical training tool 130 inthe virtual operative environment 128. In this regard, the task pathincludes position coordinates of the virtual surgical training tool 130relative to position coordinates of one or more structures beingoperated on by the virtual surgical training tool 130 in the virtualoperative environment 128. In some embodiments, certain time-indexedevents are also included in the task path or a set of task paths (asdiscussed above). At step 510, the performance of one or more operativetasks (i.e., one or more simulation objectives) is assessed based uponthe task path. The task performance may be assessed continuously,periodically, upon the occurrence of certain triggering events, orpost-performance of the one or more operative tasks (e.g.,post-simulation) by an on-site processor 124 or remotely, for example,by a remote server 136.

Those having skill in the art will appreciate that there are variousvehicles by which processes and/or systems and/or other technologiesdescribed herein can be embodied (e.g., hardware, software, and/orfirmware), and that the preferred vehicle will vary with the context inwhich the processes and/or systems and/or other technologies aredeployed. In some embodiments, various steps, functions, and/oroperations are carried out by one or more of the following: electroniccircuits, logic gates, multiplexers, programmable logic devices, ASICs,analog or digital controls/switches, microcontrollers, or computingsystems. A computing system may include, but is not limited to, apersonal computing system, mainframe computing system, workstation,image computer, parallel processor, or any other device known in theart. In general, the term “computing system” is broadly defined toencompass any device having one or more processors, which executeinstructions from a carrier medium. Program instructions implementingmethods such as those described herein may be transmitted over or storedon carrier media. A carrier medium may include a transmission mediumsuch as a wire, cable, or wireless transmission link. The carrier mediummay also include a storage medium such as a read-only memory, a randomaccess memory, a magnetic or optical disk, or a magnetic tape.

All of the methods described herein may include storing results of oneor more steps of the method embodiments in a storage medium. The resultsmay include any of the results described herein and may be stored in anymanner known in the art. The storage medium may include any storagemedium described herein or any other suitable storage medium known inthe art. After the results have been stored, the results can be accessedin the storage medium and used by any of the method or systemembodiments described herein, formatted for display to a user, used byanother software module, method, or system, etc. Furthermore, theresults may be stored “permanently,” “semi-permanently,” temporarily, orfor some period of time. For example, the storage medium may be randomaccess memory (RAM), and the results may not necessarily persistindefinitely in the storage medium.

Although particular embodiments of this invention have been illustrated,it is apparent that various modifications and embodiments of theinvention may be made by those skilled in the art without departing fromthe scope and spirit of the foregoing disclosure. Accordingly, the scopeof the invention should be limited only by the claims appended hereto.

What is claimed is:
 1. A system for surgical training, comprising: asurgical training tool, the surgical training tool including one or morefiducials; a support structure for receiving the surgical training toolto constrain manipulation of the surgical training tool within a volume;at least two off-tool detectors configured to detect the position of theone or more fiducials within the volume; at least one processor incommunication with the at least two off-tool detectors; a tool pathgenerated by the at least one processor based on the detected positionof the one or more fiducials; a virtual rendering of the surgicaltraining tool in a virtual operative environment, the virtual renderingof the surgical training tool being visually observable via a displaydevice, an operative task being performed within the virtual operativeenvironment utilizing the virtual surgical training tool presented bythe display device, the virtual surgical training tool being manipulatedbased on the tool path; and at least one time, space, and event basedtask path generated and graphically represented by the at least oneprocessor based on the tool path, the at least one task path describinga path of the virtual surgical training tool in the virtual operativeenvironment, the at least one task path including a plot of positioncoordinates of the virtual surgical training tool relative to positioncoordinates of one or more structures being operated on by the virtualsurgical training tool in the virtual operative environment over time,the at least one task path further including time-indexed events basedon the tool path, wherein the time-indexed events include performedoperative tasks and detected errors indicated with markings atrespective x, y, and z coordinates relative to time on the at least onetask path in addition to a graphically represented plot of the positioncoordinates of the virtual surgical training tool relative to theposition coordinates of one or more structures being operated on by thevirtual surgical training tool in the virtual operative environment overtime, wherein the time-indexed events include at least a first event anda second event each comprising a performed operative task and/ordetected error, wherein a first time interval for the first eventrequires a first set of spatial boundaries for the at least one taskpath and a second time interval for the second event requires a secondset of spatial boundaries for the at least one task path that isdifferent from the first set of spatial boundaries, and wherein a firsterror threshold is established for the first time interval and a seconderror threshold is established for the second time interval; wherein themarkings are distinguishable from the plot of the position coordinates.2. The system of claim 1, wherein the detected errors include one ormore of: a dropped object, a misaligned cut, or a deviation beyond aspatial threshold.
 3. The system of claim 1, wherein the at least oneprocessor is further configured to: assess the performance of theoperative task based upon the at least one task path by evaluatingtime-indexed events within a time interval for the operative task todetermine performance or non-performance of events required by theoperative task and based on an error threshold for the operative task.4. The system of claim 3, wherein the assessment is performedcontinuously or periodically.
 5. The system of claim 3, wherein theassessment is performed after the performance of the operative task. 6.The system of claim 1, further comprising: a storage medium configuredto store the at least one task path or a recording of the virtualsurgical training tool being manipulated within the virtual operativeenvironment.
 7. The system of claim 1, further comprising: acommunication link configured to transfer the at least one task path ora recording of the virtual surgical training tool being manipulatedwithin the virtual operative environment to a remote server forassessing the performance of the operative task based upon the at leastone task path or the recording of the virtual surgical training toolbeing manipulated within the virtual operative environment.
 8. Thesystem of claim 7, further comprising: a web portal observable on thedisplay, the web portal including one or more access links to thevirtual rendering of the surgical training tool in the virtual operativeenvironment.
 9. The system of claim 8, wherein the web portal furtherincludes a continuous, periodic, or event-triggered assessment of theperformance of the operative task based upon the at least one task pathor a recording of the virtual surgical training tool being manipulatedwithin the virtual operative environment.
 10. The system of claim 1,wherein the surgical training tool comprises a laparoscopic tool or amodel of a laparoscopic tool.
 11. The system of claim 1, wherein the atleast two off-tool detectors include two or more cameras configured forstereoscopic imaging.
 12. The system of claim 1, wherein the at leasttwo off-tool detectors are positionable relative to the supportstructure.
 13. The system of claim 1, wherein the support structure iscollapsible or capable of being disassembled.
 14. The system of claim 1,further comprising: a portable container configured to store the supportstructure, the surgical training tool, and the at least two off-tooldetectors.
 15. The system of claim 1, wherein the one or more fiducialsinclude one or more traceable markers or recognizable features includedin or coupled to the surgical training tool.
 16. The system of claim 1,further comprising: at least a second surgical training tool, the secondsurgical training tool including one or more fiducials, wherein the atleast two off-tool detectors are further configured to detect theposition of the one or more fiducials of the second surgical trainingtool within the volume; a second tool path generated by the at least oneprocessor based on the detected position of the one or more fiducials ofthe second surgical training tool; and a virtual rendering of the secondsurgical training tool in the virtual operative environment, the secondvirtual surgical training tool being manipulated based on the secondtool path.
 17. The system of claim 1, wherein the markings intersect theplot of the position coordinates.
 18. The system of claim 1, wherein themarkings comprise vertical lines disposed at respective x, y, and zcoordinates relative to time on the at least one task path.
 19. A systemfor surgical training, comprising: a surgical training tool, thesurgical training tool including one or more fiducials; a collapsiblesupport structure for receiving the surgical training tool to constrainmanipulation of the surgical training tool within a volume, thecollapsible support structure including a top surface and a bottomsurface connected to one another by cross bars in a scissor-likearrangement, wherein the cross bars are configured to actuate the topsurface towards the bottom surface when the cross bars are transitionedfrom an open position to a closed position; at least two off-tooldetectors configured to detect the position of the one or more fiducialswithin the volume; at least one processor in communication with the atleast two off-tool detectors; a tool path generated by the at least oneprocessor based on the detected position of the one or more fiducials; avirtual rendering of the surgical training tool in a virtual operativeenvironment, the virtual rendering of the surgical training tool beingvisually observable via a display device, an operative task beingperformed within the virtual operative environment utilizing the virtualsurgical training tool presented by the display device, the virtualsurgical training tool being manipulated based on the tool path; and atleast one time, space, and event based task path generated andgraphically represented by the at least one processor based on the toolpath, the at least one task path describing a path of the virtualsurgical training tool in the virtual operative environment, the atleast one task path including a plot of position coordinates of thevirtual surgical training tool relative to position coordinates of oneor more structures being operated on by the virtual surgical trainingtool in the virtual operative environment over time, the at least onetask path further including time-indexed events based on the tool path,wherein the time-indexed events include performed operative tasks anddetected errors indicated with markings at respective x, y, and zcoordinates relative to time on the at least one task path in additionto a graphically represented plot of the position coordinates of thevirtual surgical training tool relative to the position coordinates ofone or more structures being operated on by the virtual surgicaltraining tool in the virtual operative environment over time, whereinthe time-indexed events include at least a first event and a secondevent each comprising a performed operative task and detected error,wherein a first time interval for the first event requires a first setof spatial boundaries for the at least one task path and a second timeinterval for the second event requires a second set of spatialboundaries for the at least one task path that is different from thefirst set of spatial boundaries, and wherein a first error threshold isestablished for the first time interval and a second error threshold isestablished for the second time interval; wherein the markings aredistinguishable from the plot of the position coordinates.